Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery

Rolando Figueroa Roberto,Yashar Javidan,Blythe Durbin-Johnson,Eric Otto Klineberg,Deepak Nallur,Flynn Andrew Rowan

doi:10.1007/s43390-021-00333-3

Rolando Figueroa Roberto, Yashar Javidan + Show 4 more

Open Access

https://doi.org/10.1007/s43390-021-00333-3

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Abstract

BackgroundSurgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital.MethodsWe queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model.Results475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied.ConclusionsA protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures.Level of evidenceLevel II.

Highlights

Surgical site infection developing after operation has been a major source of patient harm, afflicting patients of all age groups and across all surgical disciplines
During the 12 month period of protocol initiation, there was incomplete adherence to the dual antimicrobial prophylaxis regimen; patients may have been treated with only one of the therapeutic agents. This resulted in four patient treatment groups—those treated with no intrawound antimicrobial agent, those treated with only 3.5% weight/volume Povidone-iodine irrigation, those treated with only intrawound Vancomycin powder, and those treated with both Povidone-iodine irrigation and intrawound Vancomycin powder
Statistical analysis in our investigation was aided by a baseline surgical site infection (SSI) rate which ranged between 7 and 14%; i.e., our ability to adequately power this study provided opportunities that did not exist at centers that had already achieved exemplary infection rates

Summary

Introduction

Surgical site infection developing after operation has been a major source of patient harm, afflicting patients of all age groups and across all surgical disciplines. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. Methods We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. Conclusions A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures.

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